KR20230137383A - Concentric tube device for minimally invasive surgery - Google Patents

Abstract

The minimally invasive surgical device includes a guide tube having a highly curved in-situ end (73) received within a channel. The highly curved in-situ end is configured with an optimized curvature for improved triangulation in the tissue workspace. The highly curved in-situ end of the guide tube extends in curved channels 32, 34 within the endoscopic device of the surgical robot. The combination of the curved channel and the highly curved in-situ end of the guide tube provides improved maneuverability in the work area. In some embodiments, the highly curved in-situ end includes nitinol and is formed to a desired curvature. The highly curved in-situ end can be bent to achieve a stable shape that can be used repeatedly. In some embodiments, each first and second guide tube has a dual curved configuration.

Description

Concentric tube device for minimally invasive surgery

The present invention relates to surgical devices and related methods for performing surgery. In particular, the present invention relates to tools and methods for minimally invasive surgery using concentric tube assemblies.

Minimally invasive surgery using electromechanical robots is a developing field of medicine. Conventional devices for performing minimally invasive surgery, such as endoscopes and resectoscopes, typically have a distal tip that is inserted through an incision or natural orifice in the patient's body. The in-situ tip has an optical lens that provides a surgeon with a view proximate to the in-situ tip when placed inside the body. Endoscopes typically have a camera attached to a lens to display the field of view on an operating room monitor. In some applications, the endoscope has a camera mounted on the in-situ tip of the endoscope. The device also has a narrow working channel extending through the device. One or more elongated surgical instruments may be inserted through the working channel. Tools such as cutting devices, baskets or laser optics may be provided in the surgical tool. The in-situ end of the surgical tool protrudes from the in-situ tip of the device, allowing the surgeon to visually observe the operation of the tool inside the patient's body during surgery.

Conventional surgical tools for use through the narrow working channels of an endoscope or resectoscope are generally limited in size and, in particular, are limited in the range of motion and freedom of manipulation of the tool end extending from the in situ end of the endoscope or resectoscope. Curved channels within the endoscope or resectoscope have been proposed as one potential solution to achieve a better range of motion and the ability to better manipulate tools in the workspace. However, providing curved channels for the passage of surgical instruments within the narrow confines of an endoscope or resectoscope presents additional challenges. For example, a curved concentric tube tends to align with the plane of curvature of the channel it contains. As a result, the curved tube of a surgical tool positioned within a curved channel on the endoscope can provide improved range of motion when extended from the in situ end of the channel, but this configuration is not the optimal solution when manipulation outside the plane of curvature of the channel is desired. does not provide

Over the past few decades, it has become increasingly clear that entering the body in the most minimally invasive way possible during surgery offers tremendous benefits to patients. Minimally invasive surgery is a general term used to describe any surgical procedure that enters the body without large, open incisions. Conventional devices for performing minimally invasive surgery, such as endoscopes or resectoscopes, are generally rigid and have an in situ tip that is inserted through an incision or natural orifice in the patient's body. The in-situ tip has an optical lens that provides a surgeon with a view proximate to the in-situ tip when placed inside the body. Endoscopes typically have a camera attached to display the field of view on an operating room monitor. In some applications, the endoscope has a camera mounted on the in-situ tip of the endoscope. The device also has a working channel extending through the device. One or more elongated surgical tools may be inserted through the working channel. Surgical tools may include tools such as cutting devices, baskets, or laser optics. The in-situ end of the surgical tool protrudes from the in-situ tip of the device, allowing the surgeon to visually observe the operation of the tool inside the patient's body during surgery.

Minimally invasive surgery involves laparoscopic surgery, which uses long, rigid instruments passed through small ports in the body to provide a view using a tube (e.g., an endoscope) to view the surgical field. In conventional laparoscopic surgery, the endoscope is usually used only to visualize the surgical site and no instruments pass through it. The instrument is rotated outside the body and through the incision port to provide instrument manipulation at the surgical site. Instrument manipulation in laparoscopic surgery is accomplished by rotating a long, rigid shaft through a port in the body. For surgeries in the distended abdomen, thoracic cavity, pelvis, or other anatomical operating spaces with sufficient space, this concept often provides an excellent minimally invasive solution to provide instrumentation. However, if the surgical site is located beneath a long, narrow channel, the ability to rotate the long, rigid shaft is reduced. As the access channel becomes longer and/or narrower, the tool's maneuverability decreases dramatically.

Minimally invasive surgery also includes endoscopic surgery. Laparoscopic surgery uses an endoscope to provide visualization, while endoscopic surgery differs in that the surgical tools pass through the working channel of the endoscope tube itself. Some examples of surgical instruments that may be used during endoscopic surgery are scissors, forceps, laser fibers, and monopolar/bipolar cautery. Endoscopes include rigid endoscopes and flexible endoscopes. Rigid endoscopes are used in surgeries that can take a straight, linear path from outside the body to the surgical site, while flexible endoscopes are used when they need to bend through curved anatomy. Rigid endoscopes are currently used in virtually every surgical field, including but not limited to neurology, thoracic surgery, orthopedics, urology, and gynecologic procedures. Rigid endoscopy is currently used for surgeries throughout the body, but it is not without drawbacks. Tools operated through the working channel of a rigid endoscope are similar to laparoscopic tools in that they are generally straight, rigid tools. Typically, these tools are limited to two degrees of freedom of motion relative to the endoscope: axial insertion/retraction and rotation. Sometimes, the surgeon may have the ability to rotate or tilt the endoscope outside the body, which makes the job particularly difficult because each time the endoscope moves, the scope's field of view moves with it. Additionally, the size constraints of the endoscopic working channel allow the surgeon to bring only one instrument at a time to the surgical site most of the time, effectively eliminating the ability to use two hands. This limitation to one instrument at a time, the constantly changing field of view, limited degrees of freedom, and lack of instrument dexterity at the endoscope tip make endoscopic surgery a particularly difficult type of minimally invasive surgery.

Because they are particularly adept at precision, spatial reasoning, and dexterity, electromechanical surgical robots have great potential to assist in manipulating surgical instruments and are a rapidly developing field of medicine. Surgical robots have been widely adopted worldwide and have been used in hundreds of thousands of procedures. Most surgical robotic systems designed to date to aid instrument manipulation can generally be classified as rotating and flexible tools. Rotating laparoscopic-like systems, such as the widely used da Vinci Xi robot made by Intuitive Surgical, Inc., can manipulate instruments in the same way that laparoscopic instruments do: by tilting them through ports in the body. For surgical applications where tools cannot be tilted or rotated outside the body, several groups in the research community have been developing robotic systems based on flexible elements. These systems are often referred to as continuum robots, or robots with an elastic structure and continuously bending. There are also concentric tube manipulators, a class of small, needle-sized continuum robots composed of concentric elastic tubes. Concentric tube robots appear to hold promise in several types of minimally invasive surgical interventions that require articulated, small-diameter robots to be inserted into the body. Examples include surgeries on the eyes, ears, sinuses, lungs, prostate, brain, and other areas. For most of these applications, higher curvature is generally desirable to allow the robot to maneuver around “tight corners” inside the human body and work proficiently in the surgical field. In the context of endoscopic surgery, the precurvature of the concentric tube determines how close the manipulator can operate to the tip of the endoscope, a very important point during endoscopic surgery.

In traditional endoscopic procedures, the surgeon typically holds the endoscope in one hand and the endoscopic instruments in the other, making it generally impossible for the surgeon to operate both instruments simultaneously. The human error aspect can lead to awkward and potentially dangerous endoscopic movements every time a surgeon has to swap one endoscopic instrument for another. However, surgeons often need the ability to manipulate two instruments precisely and simultaneously in certain situations, especially when attempting to precisely grasp, manipulate, and cut material. Even if an endoscope can accommodate more than one tool simultaneously, the tools can only be oriented straight and parallel to the other tools, which prohibits true collaboration between the tools. Although surgeons benefit greatly from the increased precision, dexterity, and vision provided by robotic surgical systems, these conventional systems have limited maneuverability.

Another problem with conventional surgical robots is that the parallel tube configuration extending from the endoscopic device does not provide triangulation of the instruments in the workspace of the field of view near the endoscopic tip. Additionally, such conventional configurations have tubes extending generally parallel along a longitudinal axis, making it nearly impossible to apply off-axis forces to push or pull tissue from side to side. This configuration also places the nominal interaction point at which the first and second tools interact well beyond the field of view and effective workspace of the endoscopic tip. As such, it is difficult to manipulate tissue using two endoscopic tools working together using conventional devices.

Therefore, what is needed are improvements in devices and methods for performing robotic surgery, particularly for controlling and manipulating the first and second tools cooperatively within the field of view near the tip of the endoscopic device.

This brief summary is provided to introduce in a simplified form a selection of concepts that will be further explained in the detailed description below. This summary is not intended to identify key features or essential features of the claimed subject matter or to be an aid in determining the scope of the claimed subject matter.

A device for performing minimally invasive surgery includes a concentric tube assembly with an in-situ tip configured for insertion into the patient's body through a small incision or orifice. The tube assembly has a channel and a guide tube received within the channel. The guide tube is configured to axially translate and rotate relative to the channel. The inner tube is located within the guide tube and can perform axial translational and rotational movements independently of the guide tube. The guide tube is operable to steer the in-situ end of the inner tube to a desired location within the tissue workspace defined at the end of the tube assembly.

The guide tube has a pre-shaped, highly-curved in-situ end. The channel also has a curved shape near the in situ opening. The curved channel and the highly curved guide tube work together to form an elbow-like configuration, allowing the guide tube to enter the tissue workspace at an angle to the centerline axis. This angled entry into the work area provides excellent triangulation and organization maneuvers.

In some embodiments, the present invention provides a device for performing surgery, comprising a surgical robot having an endoscopic device extending from the surgical robot, the endoscopic device having an outer sheath, an inner sheath, and a channel disposed within the inner sheath. , provides a device for performing surgery. A guide tube is positioned within the channel, the guide tube having a proximal end extending toward the surgical robot and a highly curved distal end extending away from the surgical instrument. An inner tube is accommodated within the guide tube, and the inner tube is capable of axial movement and rotation relative to the guide tube. The highly curved in-situ end of the guide tube has a curvature of between about 50 m^(-1) and about 100 m^(-1).

In a further embodiment, the highly curved in-situ end of the guide tube has a curvature between about 50 m^(-1) and about 100 m^(-1).

In a further embodiment, the present invention provides an apparatus for performing surgery, comprising a surgical robot having an endoscopic device extending from the surgical robot, the endoscopic device having an outer sheath, an inner sheath, and a first and first sheath disposed within the inner sheath. An apparatus for performing surgery is provided, having two channels. A first guide tube is positioned within the channel, the first guide tube having a proximal end extending toward the surgical robot and a first highly curved distal end extending away from the surgical robot. A second guide tube is positioned within the channel, the second guide tube having a proximal end extending toward the surgical robot and a second highly curved distal end extending away from the surgical robot. The first inner tube is accommodated within the first guide tube, and the first inner tube is capable of axial movement and rotation relative to the first guide tube. The second inner tube is accommodated within the second guide tube, and the second inner tube is capable of axial movement and rotation relative to the second guide tube. The first highly curved in-situ end of the first guide tube has a curvature of between about 50 m^(-1) and about 100 m^(-1), and the second highly curved in-situ end of the second guide tube has a curvature of about 50 m^(-1). It has a curvature between m^(-1) and about 100 m^(-1).

In a further embodiment, the first highly curved in-situ end of the first guide tube has a curvature of about 72 m^(-1), and the second highly curved in-situ end of the second guide tube has a curvature of about 72 m^(-1). ) and has a curvature of

Another object of the present invention is to provide an apparatus and method for effectively manipulating tissue using first and second tools in the field of view near the tip of an endoscopic device.

Numerous other objects, advantages and features of the present invention will become readily apparent to those skilled in the art upon review of the following drawings and description of the preferred embodiment.

1 is a side perspective view of one embodiment of a minimally invasive surgical device according to the present invention.
Figure 2 is a detailed side view of the minimally invasive surgical device of Figure 1;
FIG. 3A is an exploded perspective view of one embodiment of the minimally invasive surgical device of FIG. 1.
FIG. 3B is a detailed exploded perspective view of one embodiment of the minimally invasive surgical device of FIG. 1.
Figure 4 is a perspective view of one embodiment of an instrument cartridge device for a minimally invasive surgical device.
Figure 5 is an exploded top view of one embodiment of a tubing assembly of a minimally invasive surgical device having an outer sheath, an inner sheath, and a sheath insert having first and second channels.
Figure 6 is a partial cross-sectional view of one embodiment of a channel insert configured to be positioned within a sheath.
Figure 7 is a perspective view of one embodiment of an in-situ end of the inner sheath having first and second channel openings and channel bushings.
Figure 8 is a perspective view of one embodiment of a sheathed insert having first and second channels.
Figure 9 is a perspective view of one embodiment of a steering plug for use in a sheathed insert.
Figure 10 is a perspective view of one embodiment of an inner sheath having first and second channels received therein.
Figure 11 is a side view of one embodiment of an inner tube.
Figure 12 is a side view of one embodiment of a high curvature guide tube.
Figure 13 is a side view of one embodiment of a combined inner tube and high curvature guide tube.
Figure 14 is a perspective view of one embodiment of a surgical robotic device including first and second highly curved guide tubes and first and second inner tubes extending therefrom.
Figure 15 is a partial cross-sectional view of one embodiment of a high curvature guide tube within a channel in a retracted position.
Figure 16 is a side view of one embodiment of a guide tube with a double curved configuration.
Figure 17 is a partial cross-sectional view of one embodiment of a guide tube with a double curved configuration positioned within a channel in a retracted position.
Figure 18 is a perspective view of one embodiment of a tissue workspace having first and second guide tubes and first and second inner tubes extending therefrom.

Although the manufacture and use of various embodiments of the invention are discussed in detail below, it should be understood that the invention provides many applicable inventive concepts to be implemented in a wide variety of specific situations. The specific embodiments discussed herein are merely illustrative of specific ways to make and use the invention and do not limit the scope of the invention. Those of ordinary skill in the art will recognize numerous equivalents to the specific devices and methods described herein. Such equivalents are considered to be within the scope of this invention and are covered by the appended claims.

In the drawings, for clarity, not all reference numbers are indicated in each drawing. Additionally, positional terms such as “top,” “bottom,” “side,” “top,” “bottom,” etc. refer to the device when in the orientation shown in the figures. Those skilled in the art will recognize that the device may assume different orientations during use.

The present invention provides a minimally invasive surgical device comprising a guide cannula having a highly curved in-situ end. The guide tube is received within a longitudinal channel along the length of an endoscope- or resectoscope-type tube assembly. In various embodiments the channel has a straight or curved outline. The guide tube has a highly curved configuration, providing excellent triangulation in the work area and maneuverability that allows the surgeon to engage tissue near the in-situ endoscope or endoscope. The parameters of curvature at the in situ end of the guide tube are optimized to provide improved performance.

The in-situ portion of the guide cannula is highly curved and configured for placement beyond the endoscope in-situ tip within the patient's body and into the tissue workspace. The in situ portion of the guide tube can be rotated and translated relative to the channel in which the guide tube is received, and an inner tube containing surgical tools (e.g., electrosurgical tools or cutting devices) can be positioned inside the guide tube and positioned within the guide tube. It may extend beyond the in situ end of the guide tube to access the tissue workspace within the field of view. The highly curved in-situ end of the guide cannula provides improved triangulation and dexterity in the work area and provides optimized performance for minimally invasive surgery.

As an example, one embodiment of a minimally invasive surgical device 100 is shown generally in Figure 1. The device includes a surgical robotic device (10) mounted on a support (12). In some embodiments, support 12 includes a robotic arm 12a extending from a stationary base 12b. Mount 14 at the end of robotic arm 12a is configured to attach to surgical robotic device 10 via struts 16 in some embodiments. Support 12 provides a programmable position control device for precisely controlling the position and orientation of surgical robotic device 10 in three-dimensional space with respect to a human or animal patient positioned on an operating table beneath the device.

The input console 200 is positioned away from the support 12 and the surgical robotic device 10. Input console 200 provides input for controlling one or more devices located on surgical robotic device 10.

With further reference to FIGS. 1 and 2 , the surgical robotic device 10 has an interface 18 connecting the rigid tubing assembly 20 with the instrument base 22 . The tube assembly 20 has a longitudinal endoscope or resectoscope type structure including an outer sheath 26 and a plurality of tubes housed within the outer sheath 26. One or more ports 27a, 27b, 27c are coupled to the tubing assembly 20 to provide irrigation, suction, or other functions during surgical procedures. The tube assembly 20 has an in-situ end 21 oriented away from the instrument base 22 for insertion into patient tissue. a camera having a lens passing through the tube assembly (20) toward the in-situ end (21) to provide visualization of the tissue working space adjacent the in-situ end (21) when the tube assembly (20) is inserted into the patient's body; 24) is located on the instrument base 22. The surgical robotic device 10 also has an adapter 14a configured to attach to the mount 14 shown in FIG. 1 .

Referring to Figure 3A, a camera 24 is positioned on the instrument base 22 to provide real-time images to a remote display for the surgeon to view during the surgical procedure. Camera 24 has a rod-shaped lens 25 extending through a longitudinal lens passage 80 within the tube assembly 20 such that the lens provides a field of view with a tissue working space just beyond the in situ tip of the tube assembly. do. In some embodiments, lens passageway 80 includes a rigid tube extending along the interior of tube assembly 20 to protect lens 25 as it is received, inserted into, and/or removed from the device. Lens passageway 80 has a funnel-shaped insertion port at the proximal end in some embodiments.

With further reference to FIGS. 3A and 3B, tube assembly 20 has an outer sheath 26 and an inner sheath 28. An annular plenum is defined between the outer surface of the inner sheath 28 and the inner surface of the outer sheath 26 through which gas or fluid may be transported during the surgical procedure.

With further reference to FIG. 3A , in some embodiments, surgical robotic device 10 includes a first tool cartridge 60a and a second tool cartridge 60b. Each tool cartridge is comprised of modular parts that can be installed within an instrument base 22. Each tool cartridge is equipped with a drive mechanism configured to manipulate an array of tubes connected to the cartridge. For example, the first tool cartridge 60a is positioned at the proximal end of the first tube array 70a such that the first tube array 70a extends toward the interface 18 and away from the first tool cartridge 60a. are combined. Similarly, second tool cartridge 60b is coupled to the proximal end of second tube array 70b such that second tube array 70b extends toward interface 18 and away from second tool cartridge 60b. do. Each tool cartridge 60a, 60b may be interchangeable with other similar tool cartridges on instrument base 22. In some embodiments, each tool cartridge is disposable.

One embodiment of an instrument cartridge 60 having an associated tube array 70 is shown in FIG. 4 . Tool cartridge 60 has a housing connected to the proximal end of tube array 70. The tube array 70 has a concentric tube array including a guide tube (or outer tube) 72 and an inner tube 74 located inside the guide tube 72. Guide tube 72 has a highly curved in-situ end 78 and an inner tube 74 protrudes out of the in-situ tip 73 of guide tube 72. The inner tube 74 in some embodiments has a surgical tool 82, such as an electrosurgical tip, cutting tool, or tissue manipulator, protruding from the in-situ end. During a surgical procedure, the inner tube 74 may be axially translated or rotated about a longitudinal axis independently of the guide tube 72. Highly curved guide tube 72 steers inner tube 74 toward a desired location within the tissue work space. The inner tube 74 is coupled to one or more internal drive elements within the tool cartridge 60 to provide independent axial translation and rotation control in some embodiments.

During use, guide tube 72 may also be translated and rotated by independent drive elements within tool cartridge 60. In this way, due to the curvature 78 of the guide tube 72, a range of motion is obtained by rotating and translating the guide tube 72 and the inner tube 74 using independent drive elements within the tool cartridge 60. You can lose.

The tube array 70 is received within a longitudinal channel assembly, or sheathed insert 30, in some embodiments internal to an endoscope or resectoscope type device. As shown in Figure 5, sheathed insert 30 has first channels 32 for receiving a first concentric tube array 70a and substantially parallel channels 32 for receiving a second concentric tube array 70b. It has a second channel (34). Sheath insert 30 is positioned axially within the endoscope or resectoscope inner sheath 28 to provide an internal channel for receiving one or more concentric tube arrays. When assembled, the first and second channels 32, 34 are located within the inner sheath 28 and the outer sheath 26 is located outside the inner sheath 28. In some embodiments, the first and second channels 32, 34 each allow each concentric tube array 70a, 70b to fit tightly therein while each guide tube 72, 172 is positioned in a corresponding channel. It has a hollow interior space forming a substantially round cross-sectional shape, dimensioned to be capable of independent rotation and translation therein.

6, one embodiment of the in-situ end of sheath insert 30 is shown next to the inner sheath on an endoscope or resectoscope. Sheathed insert 30 has a first channel 32 and a second channel 34. The first and second channels 32, 34 branch off at the in-situ ends. The first channel 32 terminates in a first channel opening 38 and the second channel 34 terminates in a second channel opening 48. Channel bushings 36 are disposed on the in-situ ends of the first and second channels 32, 34 at the in-situ ends of the sheathed insert 30. In some embodiments, channel bushing 36 surrounds the in-situ ends of first and second channels 32, 34. Channel bushings 36 provide support for the first and second channels 32, 34 in the divergence region. Channel bushings 36 also engage the inner walls of the inner sheath 28 to properly align the first and second channels 32, 34 in the desired positions on the in-situ openings 50 of the inner sheath 28. interface). In some embodiments, channel bushing 36 has a channel bushing width 49 that is substantially equal to the inner diameter 51 of inner sheath 28 at in-situ opening 50. Channel bushing 36 contains polymer material in some embodiments. As shown in Figure 6, the lens groove 53 provides the channel bushing 36 with a recess shaped to receive a rod lens coupled to the camera. The channel bushing 36 and the first and second channels 32, 34 are coupled such that the entire assembly can be axially inserted into the inner sheath 28 or pulled axially from the inner sheath 28 after use. Sheathed insert 30 is disposable in some embodiments. In other embodiments, sheathed insert 30 is interchangeable with other similar sheathed inserts. For example, for a particular procedure, it may be desirable to use first and second channels 32, 34 with specific characteristics, such as inner diameter, channel shape, or curvature of the in-situ end. However, for other procedures, it may be desirable to use first and second channels 32 and 34 with different characteristics. Accordingly, using the systems and methods of the present invention, a user can exchange sheathed inserts 30 with different characteristics for different surgeries.

Referring to Figure 7, one embodiment of a sheathed insert 30 having first and second channels 32 and 34 is shown. The first channel 32 opens at the first channel in-situ opening 38 and the second channel 34 opens at the second channel in-situ opening 48. The first and second channel in-situ openings 38, 48 are spaced apart by a channel spacing 55. In some embodiments, channel spacing 55 is larger than the inner diameter of the first or second channels 32, 34. In some embodiments, channel spacing 55 is greater than about twice the inner diameter of first channel 32 or second channel 34. The first and second channel in-situ openings 38, 48 are spaced apart from each other as both the first and second channels 32, 34 are curved away from each other in an axial centerline of the inner sheath 28. As shown in Figure 7, the lens may be positioned within the lens groove 53 within the inner sheath 28 over the channel bushing 36.

Referring again to Figures 5 and 8 and 9, in some embodiments, sheathed insert 30 is connected at one end to first and second channels 32, 34 and connected to tube arrays 70a, 70b. and an interface 18 providing a rigid funnel-shaped structure open at the other end for insertion of the rod lens 25 of the camera 24. For example, in some embodiments, steering plug 40 is located within interface 18. Steer plug 40 has a first port 42 configured to receive longitudinal insertion of a first tube array 70a (coupled in some embodiments to a first cartridge 60a) and a second tube array 70b. ) (in some embodiments coupled to the second cartridge 60b). The steering plug 40 also defines a lens insertion port 46 positioned to accommodate longitudinal insertion of a rod lens 25 in some embodiments.

The steering plug 40 has a sheathed adapter 45 surrounding the proximal ends of the first and second channels 32, 34, as shown in Figure 8. Sheath adapter 45 is similar in shape and function to channel bushing 36 in some embodiments. The sheath adapter 45 has an outer diameter similar to the inner diameter of the inner sheath 28 such that when received in the inner sheath 28, the sheath adapter 45 fits tightly along the inner wall of the inner sheath 28. A lens guide 43 is formed on the sheath adapter, forming a groove that receives a portion of the lens passing longitudinally along the inner length of the inner sheath 28. The insert bushing (41) forms a rigid cylinder configured to engage with the inner sheath (28) at the proximal end of the sheath adapter (45). In some embodiments, the insert bushing 41 forms a seal around the interior of the inner sheath 28 of the endoscope or resectoscope.

As shown in Figure 9, steering plug 40 may be formed from a single piece of non-metallic material, such as a polymer material. The steering plug 40 can be removed from the interface 18 and replaced. In some embodiments, steering plug 40 is disposable. Steer plug 40 may be secured in place within interface 18 using a friction fit in some embodiments. Steer plug 40 may also fit tightly within the inner contour of interface 18 to form a seal between interface 18 and steer plug 40 in some embodiments.

The steering plug 40 has a first socket 132 shaped to receive the proximal end of the first channel 32 and a second socket 134 shaped to receive the proximal end of the second channel 34. Equipped with The lens guide 43 defines a hollow passageway within the sheath adapter 45 that is shaped to accommodate the passage of a lens, such as a fiber optic lens, through the steering plug toward the in-situ end of the endoscope or resectoscope. As shown in Figure 10, the proximal end of the first channel 32 may fit tightly within the first socket 132 shown in Figure 9, and similarly, the proximal end of the second channel 34 may fit tightly within the first socket 132 shown in Figure 9. The position end may be tightly fitted inside the second socket 134. Accordingly, the first and second channels 32 and 34 may be in open communication with the first port 42 and the second port 44 shown in FIG. 5, respectively. A first tube array, comprising a guide tube (72) and an inner tube (74), may be positioned through the steering plug (40) into the first port (42) and into the first channel (32). Similarly, a second tube array comprising a second guide tube 172 and a second inner tube 174 passes through the steering plug 40 into the second port 44 and into the second channel 34. can be located

11-13, the present invention provides a tube array comprising a substantially straight inner tube (74) positioned within a guide tube (72) having a highly curved in-situ end (73). The inner tube 74, in some embodiments, carries a surgical instrument positioned at the in-situ tip. The inner tube 74 is substantially straight along its length, although some embodiments may gain some curvature due to use in curved channels and/or curved guide tubes. Since the inner tube 74 is received inside the guide tube 72 having a highly curved end, the inner tube 74 can obtain a slight curvature during use by being slightly deformed by the curved guide tube in which it is received. In some embodiments, the inner tube 74 has an in-situ end with a curvature of less than about 10 m^(-1) with a radius greater than about 100 mm. In some embodiments, the inner tube 74 has a portion having a radius between about 100 mm and about 500 mm.

12, the guide tube (or external tube) 72 has a highly curved in-situ end 73. The guide tube 72 contains nitinol in some embodiments, and the curvature of the highly curved in-situ end 73 of the guide tube 72 is shaped to a desired curvature to provide optimized performance. In some embodiments, the curvature of the highly curved in-situ end 73 of guide tube 72 is between about 50 m^(-1) and about 100 m^(-1). In a further embodiment, the highly curved in-situ end 73 of guide tube 72 is formed with a curvature between about 60 m^(-1) and about 80 m^(-1). In a further embodiment, the highly curved in-situ end 73 of the guide tube 72 is formed with a curvature of approximately 72 m^(-1) to provide optimized performance and operability in the work space.

With further reference to FIG. 13 , when the inner tube 74 is positioned within the guide tube 72, the less curved configuration of the inner tube 74 slightly straightens the in-situ end 73 of the guide tube 72; Additionally, the curvature of the in-situ end 73 of the guide tube 72 is reduced to a curvature of between about 60 m^(-1) and about 65 m^(-1). In a further embodiment, the combined inner tube 74 and guide tube 72 have an in-situ tip 73 having a combined effective curvature of about 63 m^(-1). In a further embodiment, the present invention provides a tube array comprising a guide tube (72) and an inner tube (74) received within the guide tube (72), wherein the tube array is greater than about 40 m^(-1) and about It has a combined curved in-situ tip with a combined effective curvature of less than 100 m^(-1). In some embodiments, these characteristics may include the first guide tube 72 and the first inner tube 74 received within the first channel 32 and the second guide tube 172 and the first inner tube 74 received within the second channel 34. Applies to both second inner tubes 174.

14, in some embodiments both the first and second guide tubes 72, 172 are curved as described above. By providing first and second guide tubes 72, 172, respectively, with highly curved in-situ ends 73, 173, the curved ends are all simultaneously positioned from the end of each channel 32, 34 at the end of the endoscope or resectoscope. It may be extended. The curvature of the first and second guide tubes 72, 172 moves the tool's operating working space closer to the tip of the endoscope and into the field of view. Additionally, the highly curved in-situ ends of the first and second guide tubes together with the diverging curvatures of the first and second channels 32, 34 provide improved triangulation in the work space. This means that the first and second inner tubes 74, 174 and the corresponding first and second surgical tools 82, 182 have less curvature in the guide tubes 72, 172 and channels 32, 34. It allows access to the midline axis (CL) at a larger approach angle compared to surgical devices. In this configuration, the first and second inner tubes 74, 174 can approach the work space at a greater triangulation angle and can apply off-axis force vectors to better manipulate tissue in the work space.

Some conventional devices have a guide tube with a curved in-situ end with about 3% strain. Such an embodiment would not be considered highly curved and would not have the triangulation benefits of the present invention. In some embodiments, the present invention provides a first guide tube (72) and a second guide tube (172) having highly curved in-situ ends (73, 173), respectively, having a strain greater than about 5%, as shown in Figure 14. As shown, it forms an elbow-shaped configuration that provides improved triangle orientation for performing surgery. In some embodiments, each guide tube 72, 172 has a highly curved in-situ end 73, 173 with a strain of about 8%. In a further embodiment, each guide tube 72, 172 has a highly curved in-situ end with a strain of between about 8% and about 10%.

The inner tubes 74, 174 are in some embodiments provided with a lower curvature configuration to provide a natural feel to the surgeon by virtue of which common surgical instruments have a reduced curvature or substantially straight orientation. For example, surgeons trained in laparoscopic equipment are accustomed to using instruments that advance axially into the workspace. For this reason, adapting a surgical robot that uses endoscopic tools to have axial translation at the in-situ tip of the tool provides an intuitive approach for the surgeon. As such, by providing an inner tube (74, 174) with a smaller curvature than the guide tube that can be retracted or extended from the in situ tip opening of the guide tube (72), the present invention allows the inner tube (74) to be positioned within the field of view of the endoscope or resectoscope. We provide a system with an intuitive configuration that allows tissue manipulation using tools on the in situ tip.

With further reference to Figure 14, although a guide tube with a highly curved in-situ end provides improved operability, having in-situ ends 32a, 34a curved, curved, and diverged away from the center line (CL) of the endoscope or resectoscope. Additional advantages are realized by providing first and second channels 32, 34. For example, as shown in Figure 14, the first channel 32 extends longitudinally within the inner sheath 28, and the first channel 32 has a curved in situ branch that diverges away from the center line CL. It has an end portion 32a. Similarly, the second channel 34 extends longitudinally within the inner sheath 28 parallel to the first channel 32, with the second channel 34 branching away from the center line CL and the first channel 34 It has a curved in-situ end (34a) facing away from (32). First and second channels 32, 34 are, in some embodiments, tubes on sheathed insert 30. Each of the first and second channels 32 and 34 provides a passageway for the first and second guide tubes 72 and 172, respectively. The first guide tube is axially translatable and rotatable within the first channel 32, and the second guide tube 172 is axially translatable and rotatable within the second channel 34. It can rotate within.

As shown in Figure 14, guide tubes 72, 172 are formed by providing the first and second channels 32, 34 with in-situ ends 32a, 34a bent away from each other and away from the center line CL. When the highly curved in-situ ends 73 and 173 of the image extend from the first and second in-situ end openings 38 and 48 of each channel, they may extend away from the center line CL at a certain angle. In some embodiments, the first and second channels 32, 34 have a curvature of about 15 m^(-1) to about 30 m^(-1). Such a range of curvature provides first and second channels 32, 34 each angled away from the center line CL at an angle of approximately 10 to 15 degrees. In this way, the first and second highly curved guide tubes 72 initially extend away from the center line CL due to the curved channels 32 and 34, and then extend again toward the center line CL. 172)'s range of motion provides excellent triangulation in the workspace adjacent to the tip of the endoscope or resectoscope. This configuration also moves the nominal interaction point to a better location closer to the endoscope, unlike similar configurations with straight channels.

15, in some embodiments, when the guide tube 72 is fully retracted within the channel 32, the curvature of the high curvature region 78 of the guide tube 72 is adjusted by the inner diameter of the channel 32. limited. From this position, the orientation of the in-situ end 73 of the guide tube 72 projects along a linear extension axis 52 that the inner tube will follow when extended relative to the guide tube 72. Because the curvature of the guide tube 72 is limited in the channel 32, the small volume of space 56 defined by the space between the extension axis 52 and the reference longitudinal axis 54 is available for use adjacent to the in-situ endoscope. It may become inaccessible in spatial areas.

16, to overcome this problem, in some embodiments, guide tube 72 includes an inverted curve or double curved configuration having a first curved region 78a and a second curved region 78b. do. The first curved area 78a has a first radius of curvature R1, and the second curved area 78b has a second radius of curvature R2. R1 and R2 are the same in some embodiments. Alternatively, R1 and R2 are different in other embodiments. The first and second curved areas 78a, 78b are curved in the same plane in some embodiments. The first curved area 78a has a first arc length, and the second curved area 78b has a second arc length that is smaller than the first arc length.

Referring to FIG. 17 , guide tube 72 having a double curved configuration defines an extension axis 52 angled toward a reference longitudinal axis 54 . As such, the second curved region 78b orients the inner tube 72 toward the centerline when the guide tube 72 is fully retracted within the channel 32. This configuration reduces the size of the space 56 to which the inner tube 74 becomes inaccessible when extended along the extension axis 52.

In some embodiments, second curved area 78b includes less than about 10.0 mm of the end of guide tube 72. In a further embodiment, second curved area 78b has a curvature of about 40 m^(-1) to provide improved range of motion. In a further embodiment, the second curved area 78b includes about 5.0 mm of the end of the guide tube 72 and has a curvature of about 35 m^(-1) to about 45 m^(-1). In some embodiments, the first region of curvature has a curvature of about 50 m^(-1) to about 100 m^(-1). In a further embodiment, the first curved region has a curvature of about 72 m^(-1) and the second curved region has a curvature of about 40 m^(-1).

In a further embodiment, the present invention provides first and second guide tubes, each guide tube having a dual curved configuration. In some embodiments, the first curved area of each guide tube has a curvature defined between about 70 m^(-1) and about 75 m^(-1). The second area of curvature of each guide tube has a curvature of approximately 40 m^(-1) along the last 5 millimeters of each guide tube.

Referring to Figure 18, the view from the distal endoscope as viewed by the surgeon during the procedure is shown. The field of view has a first highly curved guide tube 72 and a first inner tube 74 extending therefrom. A second high curve guide tube 172 is also shown, having a second inner tube 174 extending therefrom. A first surgical tool 82 is disposed on the first inner tube 74, and a second surgical tool 182 is disposed on the second inner tube 174. The first and second inner tubes 74, 174 can be axially translated and rotated relative to each guide tube 72, 172, and the first and second inner tubes 74, 174 cooperate to Manipulate the organization.

In a further embodiment, the present invention provides a method of performing minimally invasive surgery. The method includes providing a surgical instrument having a base and a tubing assembly. The tube assembly includes a channel and a guide tube disposed within the channel, wherein the guide tube is axially movable and rotatable within the channel. The guide tube has a proximal portion and a highly curved distal portion distal to the base. The inner tube may be received within the guide tube from the base to the in-situ tip of the tube assembly. The method includes rotating the proximal portion of the guide tube to cause a corresponding rotation of the distal end of the guide tube; Translating the guide tube to a desired location in the tissue workspace; Translating the inner tube through the highly curved guide tube until the in-situ end of the inner tube is guided by the guide tube to a desired location within the tissue work space; And a step of performing surgery using surgical tools is provided.

Accordingly, although specific embodiments of the present invention of novel and useful concentric tube devices for minimally invasive surgery have been described, such references are not intended to be construed as limitations on the scope of the present invention.

100: Minimally invasive surgical device
10: Surgical robotic device
12: support
12a: Robotic arm
12b: fixed base
14: Mount
14a: adapter
16: Brace
18: interface
20: Pipe assembly
21: In-situ end
22: Instrument base
24: Camera
25: (bar) lens
26: outer covering
27a, 27b, 27c: Ports
28: inner covering
30: covering insert
32: first channel
32a: In-situ end
132: first socket
34: second channel
34a: In-situ end
134: second socket
36: Channel bushing
38: first channel (in situ) opening
40: steering plug
41: Insert bushing
42: first port
43: Lens guide
44: second port
45: Cloth adapter
46: Lens insertion port
48: Second channel (in situ) opening
49: Channel bushing width
50: In-situ opening
51: inner diameter
52: extension axis
53: Lens groove
54: reference breeder
55: Channel spacing
56: space
60: Tool cartridge
60a: first tool cartridge
60b: second tool cartridge
70: tube array
70a: First (concentric) tube array
70b: Second (concentric) tube array
72: (1st) guide pipe (external pipe)
172: Second guide hall
73, 173: In-situ tip (end)
74: (1st) inner tube
174: second inner tube
78: In-situ end, curve, high curve area
78a: first curved area
R1: first radius of curvature
78b: second curved area
R2: second radius of curvature
80: Lens passage
82: (No. 1) Surgical instruments
182: Second surgical tool
200: input console
CL: center line (axis)

Claims (20)

A device for performing surgery, comprising:
A surgical robot, comprising: an endoscopic device extending from the surgical robot, the endoscopic device having an outer sheath, an inner sheath, and a channel disposed within the inner sheath;
a guide tube positioned within the channel, the guide tube having a proximal end extending toward the surgical robot and a highly curved distal end extending away from a surgical instrument; and
an inner tube accommodated within the guide tube, the inner tube capable of axial movement and rotation with respect to the guide tube; Including,
A device wherein the highly curved in-situ end of the guide tube has a curvature of between about 50 m^(-1) and about 100 m^(-1). According to claim 1,
A device wherein the highly curved in-situ end of the guide tube has a curvature of between about 70 m^(-1) and about 75 m^(-1). According to claim 1,
A device wherein the highly curved in-situ end of the guide tube has a curvature of approximately 72 m^(-1). According to claim 1,
A device wherein the combination of the guide tube and the inner tube housed within the guide tube has a combined effective curvature of between about 40 m^(-1) and about 100 m^(-1). According to claim 1,
A device wherein the combination of the guide tube and the inner tube housed within the guide tube has a combined effective curvature of between about 60 m^(-1) and about 65 m^(-1). According to claim 1,
A device wherein the combination of the guide tube and the inner tube housed within the guide tube has a combined effective curvature greater than about 40 m^(-1). According to claim 1,
A device wherein the combination of the guide tube and the inner tube housed within the guide tube has a combined effective curvature greater than about 63 m^(-1). According to claim 1,
The device wherein the guide tube has a first curved area and a second curved area. According to clause 8,
The device wherein the first curved area and the second curved area are oriented in opposite directions in substantially the same plane of curvature. According to clause 9,
The first curved region has a first arc length, the second curved region has a second arc length that is less than the first arc length, and the second curved region has a range of about 35 m^(-1) to A device having a curvature of approximately 45 m^(-1). According to claim 1,
A device wherein the highly curved in-situ end of the guide tube contains nitinol. According to claim 1,
A device wherein the channel disposed within the inner sheath is curved. According to claim 12,
A device wherein the curvature of the channel is less than the curvature of the highly curved in-situ end of the guide tube. According to claim 13,
A device wherein the inner tube is curved. According to claim 14,
A device wherein the curvature of the inner tube is less than the curvature of the high curvature in-situ end of the guide tube and less than the curvature of the channel. A device for performing surgery, comprising:
A surgical robot, comprising: an endoscopic device extending from the surgical robot, the endoscopic device having an outer sheath, an inner sheath, and first and second channels disposed within the inner sheath;
A first guide tube positioned within a channel, the first guide tube having a proximal end extending toward the surgical robot and a first highly curved distal end extending away from the surgical robot. ;
A second guide tube positioned within the channel, the second guide tube having a proximal end extending toward the surgical robot and a second highly curved distal end extending away from the surgical robot. ;
a first inner tube accommodated within the first guide tube, the first inner tube capable of axial movement and rotation relative to the first guide tube; and
a second inner tube accommodated within the second guide tube, the second inner tube capable of axial movement and rotation relative to the second guide tube; Including,
The first highly curved in-situ end of the first guide tube has a curvature of between about 50 m^(-1) and about 100 m^(-1),
The device of claim 1, wherein the second highly curved in-situ end of the second guide tube has a curvature of between about 50 m^(-1) and about 100 m^(-1). According to claim 16,
The first highly curved in-situ end of the first guide tube has a curvature of about 72 m^(-1),
The device wherein the second highly curved in-situ end of the second guide tube has a curvature of about 72 m^(-1). According to claim 17,
The combination of the first guide tube and the first inner tube housed within the first guide tube has a combined effective curvature of between about 60 m^(-1) and about 65 m^(-1),
A device wherein the combination of the second guide tube and the second inner tube housed within the second guide tube has a combined effective curvature of between about 60 m^(-1) and about 65 m^(-1). According to claim 16,
The combination of the first guide tube and the first inner tube accommodated within the first guide tube has a combined effective curvature greater than about 40 m^(-1),
A device wherein the combination of the second guide tube and the second inner tube received within the second guide tube has a combined effective curvature greater than about 40 m^(-1). According to claim 16,
The high curved in-situ end of the first guide tube has a double curved configuration having a first curved region and a second curved region, wherein the first curved region ranges from about 50 m^(-1) to about 100 m^( -1), and the second curved area has a curvature of about 35 m^(-1) to about 45 m^(-1),
The high curved in-situ end of the second guide tube has a double curved configuration with a third curved region and a fourth curved region, wherein the third curved region ranges from about 50 m^(-1) to about 100 m^( -1), and the fourth curved area has a curvature between about 35 m^(-1) and about 45 m^(-1).